The plan administrator is typically the entity or company that establishes the long-term disability benefits plan for employees under ERISA. Plan provisions may vary according to the benefits that the specific company offers. In most cases, any lawsuits that are filed are served on the plan administrator.
In contrast, the claims administrator is the entity that decides eligibility for coverage and benefits when an employee files an LTD claim. In most cases, the claims administrator is the insurance company issuing the policy to fund the benefits available through the plan.
ERISA places many specific requirements on plan and claims administrators concerning the processing of claims. These largely procedural requirements are aimed at making the process fairer for claimants. For instance, administrators must process claims within a specific timeframe. Although they can seek an extension of the timeframe, they cannot do so unless they promptly notify the claimant. They also must notify claimants of any new or additional evidence that they received and allow claimants to respond.
Likewise, administrators who issue a denial of benefits must fully explain the rationale for their denial. More specifically, administrators must explain why any medical opinions that conflict with their denial are invalid. Claimants also have the right to disclosure of their entire claims file from administrators at no cost to them.
Administrators also must give clear information to those individuals whose claims they have denied about their appeal rights, including the due date of the appeal and other essential information. Similarly, they must process appeals within specific timeframes. If administrators fail to comply with any of the Department of Labor regulations, the claimant can assume that he or she has exhausted all administrative remedies under the plan and go straight to court to challenge the denial of LTD benefits. This benefit may prevent administrators from unduly extending or dragging out the claims process that claimants typically must complete before they can go ask a court to review the decision.
Bonnici Law Group provides client-focused representation throughout the ERISA claims process. We are here to consider the evidence in support of your ERISA long-term disability claim and evaluate your application. Next, we can develop the most effective strategy for fighting any denials of coverage that you may receive. Allow us to handle your legal needs while you focus on your physical and emotional health. Contact the ERISA long-term disability attorneys of Bonnici Law Group at 619-259-5199 or firstname.lastname@example.org.